Dental method and apparatus



NOV. 24, 1970 CERVERIS 3,541,690

DENTAL METHOD AND APPARATUS Filed March 11, 1968 /a /8 I6 12 I6 /2 INVENTOR ALBERT R. CERVER/S, DECEASED BY JEANNE CERVER/S,EXEGUTR/X BY TORNEYS United States Patent 3,541,690 DENTAL METHOD AND APPARATUS Albert R. Cerveris, deceased, late of Bethel Park, Pa.,

by Jeanne I. Cerveris, executrix, 5671 Villahaven Drive,

Bethel Park, Pa. 15102 Filed Mar. 11, 1968, Ser. No. 712,300 Int. Cl. A61c 9/00 U.S. Cl. 32-19 17 Claims ABSTRACT OF THE DISCLOSURE Disclosed herein are methods for adjusting the mandible of a human mouth and its condyles so as to put them in a natural and comfortable position (i.e. their centric position). This is accomplished by applying an expanding pressure, as with inflated and compressed endotrachial cuffs, between the teeth until the mandible is located into its centric position, then using the basic technique of vibration as described in U.S. Pat. No. 3,098,298 to bypass elevator muscles and elevate the mandible into first tooth contact, whereby irregularities may be indicated and later removed.

Also disclosed herein is an apparatus for diagnosing mandibular problems and aiding in their cure which is comprised of an independent pair of endotrachial cuffs each connected to their own manometer so as to show by pressure movement in the manometer a movement of the mandible toward its centric position.

Further disclosed herein is a method of forming a fully equilibrated false denture which basically comprises performing the above equilibration techniques using a moldable false denture in the mouth.

BACKGROUND OF THE INVENTION This invention relates to dental methods and apparatus. More specifically, this invention relates to methods and apparatus for achieving centric occlusion of teeth and equilibration of the mandible and its condyles.

For many years the dental profession has been cognizant of the need to achieve accurate centric equilibration of the upper and lower teeth in the human mouth in order to eliminate various discomforts and painful syndromes.

Up to 1963, centric equilibration of teeth had been accomplished mainly through the use of a spot grinding technique. This technique generally comprised having a patient hold an indicating means between his upper and lower teeth, then having either the patient by quick biting or the dentist through manual manipulation of the lower jaw, tap the patients lower teeth against the upper teeth and thereby make high spot marks on the indicating means. These high spots, which were thought to be the true cause of premature contact that prevented centric equilibration, could then be spot-ground by conventional grinding means to reduce their height and achieve What was thought to be accurate centric equilibration of the upper and lower teeth. The continuance, however, of painful syndromes lead to further research in this area.

In 1963, U.S. Pat. No. 3,098,298 issued to applicant and disclosed to the dental profession that the spotgrinding technique was not, in fact, achieving accurate centric occlusion of the teeth because of a built-in inaccuracy in its operation which in many instances was so great as to render the treatment ineffective for its intended purpose. The built-in inaccuracy, it was discovered, is due to an involuntary shift that the muscles and lower jaw (mandible) make in order to avoid the irritation caused by a high spot in the teeth which is preventing the comfortable condition of centricity from being realized. Thus, when the patient or dentist under the spot-grinding technique, tapped the patients mandibular (lower) teeth against the maxillary (upper) teeth thereby to form high spot marks on the indicating means located between the mandibular and maxillary teeth, the built-in involuntary correctional shift of irritation avoidance caused unoffending areas to be accidently marked as high spots for removal.

Based upon these findings, U.S. Pat. No. 3,098,298 disclosed the invention of a very successful and highly accurate method and means for overcoming the abovedescribed problem arising out of the earlier prior art. Because the same basic method and means are used in this invention to achieve even more beneficial dental results through further manipulations not heretofore disclosed, the entire disclosure of the above-cited patent is incorporated herein by reference.

The success and accuracy of the novel set-up disclosed in U.S. Pat. No. 3,098,298, is based upon the finding that if vertical reciprocal vibrations are imparted to the mandible with sufficient frequency and intensity, there will be produced two fundamentally important results; firstly, the stimulation of the depressor muscles and the retrusion of the condyles of the mandible to produce correct centric relation; and, secondly, sufficient impact intensity to drive the mandible through the correct physiologic arc of closure while the depressor muscle complex is in force.

As disclosed in U.S. Pat. No. 3,098,298, retrusion of the condyles is the key to the accuracy of this technique and eventual correct centric relation of the teeth. Although not bound by any theory as to the exact mechanism of what is occurring therein, a logical and clinically accepted explanation of what is taking place during the application of this technique is as follows:

When external elevating pressure is lightly applied to the mandible in its rest position, certain muscles, namely the supra and infra hyoid groups, the lateral pterygoids and elements of the platysma, will contact against pressure. When the external elevating pressure is of sufficient intensity, the mandible will automatically seek to brace itself. Because the depressor muscle action is in force, the mandible cannot brace itself by the occlusion of the teeth so the bracing action can only be obtained with the retruded condyle heads in a braced position in the fossae. When the mandible, from the rest position, accepts the vibrations with the condyles braced and with the depressing muscles in force, the vibrations will drive the mandible through the depressing muscle action to tooth contact. When tooth contact is achieved under these conditions, the teeth will vibrate vertically against each other in the correct centric occlusion. Interferences to the correct centric occlusion may then be accurately recorded and removed either by conventional grinding or by using a grinding compound in place of the above-described indicating means and allowing the vertically applied vibrations to do the grinding. The accuracy of this technique, of course, stems from the fact that it does not use the deflecting muscles, but rather bypasses them to achieve closure.

As stated hereinabove, the invention described in U.S. Pat. No. 3,098,298, has proved very successful in achieving highly accurate centric equilibration of the occlusions of the upper and lower teeth. This accurate centric equilibration of occlusions, furthermore, results in a total of almost total elimination of pain and other symptomatic trauma which occur in a. large number of patients. However, a significant number of patients after this treatment, still may experience discomfort in the form of muscle spasms and other painful syndromes.

The present invention seeks to eleviate or eliminate not only the pain caused by improper occlusion of the upper and lower teeth, but also the muscle spasms and other painful syndromes that might remain even after correct centric occlusion of the teeth is achieved.

Forming a basis for the accomplishment of these results is the finding that a large majority of the remaining painful spasms and syndromes are due to the mandible itself (and its condyle heads), as opposed to only occlusions of the teeth, being in noncentric, migrated, or shifted position in its vertical, horizontal, and/or intermediate planes. Such migration or shifting, it has been further found, is most likely caused by high or low spots in the teeth. That is to say, if, for example, certain teeth are too low or too high; if fillings in the teeth are too low or high; if teeth are missing; or if bridgework is improperly constructed, such conditions, when the mandibular (lower) teeth are repeatedly closed upon the maxillary (upper) teeth as in swallowing or chewing, cause various elevating muscles to shift automatically or cause a migration of the mandible (and its condyles) in its vertical plane to avoid the irritating condition. Such migration or shifting causes abnormal stretching of certain muscles and other tissues of the 'mouth and head, which results in spasms and other painful syndromes.

This shift or mandibular migration of avoidance in the vertical plane may occur as a rotation wherein one condyle head is elevated in the vertical plane with respect to the other condyle head, as would be the situation where teeth were missing from one side of the mandible. This shift of avoidance or mandible migration may also occur as an unnatural and noncentric raising or lowering of both condyle heads together toward or away from their fossae, as would be the situation where the front teeth (bicuspids, for example) are higher than the back teeth (molars, for example) or vice versa. This shift or migration, of course, may also be a combination of the above two types of shift, thus resulting in an intermediate vertical plane positioning of the mandible and condyles.

What is meant by the vertical plane herein is that plane which extends broadly from the bottom of the head to the top of the head as opposed to the horizontal plane which extends from the front of the head (mouth) through to the back of the head.

The above finding, then, forms a basis for the present invention when coupled with the knowledge that the condyle-fossae joint is not a bone-to-bone contacting joint in the ordinary sense of the term. The condyle-fossae joint is rather a suspended joint held by ligaments and muscles and thus is free to move in all directions within the limits of the suspending tissue.

SUMMARY OF THE INVENTION In accordance with one aspect of this invention, a mandible and its condyle heads are temporarily equilibrated by providing a compressed resilient pressure between the partially closed but separated teeth for a time sufiicient to allow the mandible to move into its centric position.

In accordance with another aspect of this invention and immediately following the above temporary equilibration of the mandible, an intermittent elevating force is applied to the mandible after the removal of resilient pressure to lift the teeth into first contact and thereby accurately indicate high and low spots on indicating means located between the teeth. The above problems of the prior art are overcome since the deflecting muscles are by-passed.

In accordance with still another aspect of this invention, the high spots and low spots so indicated are then adjusted by various techniques in order to provide permanent equilibration of the mandible. Since no impediment to centricity now exists, the muscles relax and painful syndromes are relieved.

In accordance with still another aspect of this invention, a false denture may be fully equilibrated by placing it, while in moldable condition. in the space of a missing natural denture and performing the above permanent equilibration technique on it.

In accordance with still another aspect of this invention, a novel apparatus is provided for use in diagnosing mandibular problems and aiding in their cure which is comprised of a set of independent pressure means, each set having its own pressure measuring device so constructed as to be able to indicate the amount of compressed resilient pressure throughout the equilibration process. The independent pressures enable the diagnosis of the direction in which the mandible has shifted in its vertical plane.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a three dimensional schematic view of a dependently pressurized apparatus which comprises one type of apparatus contemplated for use in this invention.

FIG. 2 is a three dimensional schematic view of an independently pressurized novel apparatus for use in mandibular diagnosis and equilibration.

As between these two figures, like parts are indicated by the same number.

DETAILED DESCRIPTION OF THE INVENTION The basic method contemplated herein for achieving general equilibration of the mandible, and thus its condyles, comprises the steps of providing a resilient pressure between the upper and lower teeth on each side of the mandible, theerafter compressing this pressure with and between the teeth and finally relaxing or opening the teeth far enough to achieve complete separation of the teeth but only far enough to maintain at least partial compression of the resilient pressure on each side of the mandible.

Although not limited to any specific theory, a clinically accepted explanation of what occurs during this process is that because the pressure is resilient, i.e., it will create a force upon compression to reestablish its original position before compression, it forces the suspended condyle heads and, therefore, the mandible into a comfortable or centric relation wherein the teeth are completely separated.

In order to achieve proper and optimum equilibration of the condyles and mandible by this method, the resilient pressure should be located at substantialy the pivotal point of mandible. By pivotal point is meant that point about which the mandible, due to the suspended nature of the condyle-fossae joint, is free to rotate in all planes. This point in the human mouth is generally located at the first mandibular molar.

The resilient pressure contemplated for use in this invention may assume many forms and be of many types. For example, such pressure may be provided by expandable and compressible resilient means such as coil springs or hydraulic lifts. However, the preferred types for the purposes of this invention are pneumatic bladders or pivots, as for example, endotrachial cuffs well known to the medical profession for use in packing throats during surgery.

It is understood, of course, that in order to achieve centric positioning of the mandible and its condyles (here in referred to as mandibular equilibration and defined as the locating of the mandible and its condyles in such a position that opening, closing, and teeth-contacting muscle action of the mouth will be natural, comfortable and not act to cause a shift of avoidance, or mandibular migration) both condyles must be coordinated throughout the process and, therefore, the resilient pressure must be located on each side of the mouth. In this respect, the resilient pressure located on either side of the mouth may be independent of or dependently connected with the pressure of the other side of the mouth, depending upon the result wished to be achieved and/or the technique used. This will be more fully discussed below.

As was alluded to hereinabove, the closing of the teeth to compress the pressure or pneumatic pivots located at the pivotal point of the mandible between the teeth establishes the force which eventually locates the mandible in its centric position. The amount of compression established may be of any reasonable magnitude as may be the degree of closure. However, in a preferred form, closure is all the way to occlusion of the teeth, without, of course, puncturing or injuring the pivot. This full occlusion closure serves the purposes of obtaining maximum displacement of the pivots and placing the condyles in maximum retrusion in the fossae so that upon initial opening of the teeth, pure rotation of the condyles may be accurately observed and achieved.

The amount of opening of the teeth may vary depending upon the result sought to be achieved. However, because all types of mandibular equilibration contemplated herein require the use of a force by compression to cause mandible relocation, the initial opening of the mouth must in all instances be only so far as to maintain at least partial compression of the resilient pressure. After mandibular relocation, of course, the mouth may be opened slightly past this point to allow for the removal of the pressure pivots or endotrachial cuffs, but action of the defleeting muscles should be avoided.

If it is desired to achieve only mandibular equilibration in the vertical plane with respect to rotary correction, i.e., where one condyle is above the other as in the case of high spots on one side of the mouth, and equilibration in the other vertical planes is not desired or found to be necessary, no further restrictions need be placed upon the amount of opening or separation. However, if accurate mandibular equilibration is to be achieved in all vertical planes and especially in the case of the noncentric raising or lowering of both condyles as in the case of back teeth being too high with respect to more forwardly located teeth, opening of the teeth should also be far enough to cause only rotational movement and not translational motion of the condyles (and thus the mandible) in their fossae.

The above described basic method, has significant utility in and of itself despite the fact that it does not establish permanent equilibration of the mandible and its condyles, since once the patient bites down from this open position, the deflecting muscles reassert the shift or migration of avoidance. Utility is realized by simply allowing the patient to rest in this positon in order to bring temporary relief from discomfort and painful syndromes. Furthermore, if the patient is permitted to hold this open but compressing position for from about 1 to about 15 minutes, oral communication by the patient to the dentist of relief of pain and location of areas of pain can be used in the diagnosis of the specific causes of the syndromes.

It is understood, of course, that the time limit set above is not necessarily the time it takes for the mandible to relocate into its centric position since this may be accomplished in some instances durng the time of opening the mouth or within a few seconds thereafter. The range of from about 1 to about 15 minutes, however, has been found suflicient to insure mandible relocation and not unduly tire the patient while at the same time permitting sufiicient time for the body to sense the elimination of pain and thereby indicate both the problem and the needed cure. Times higher than 15 minutes may be used as desired and necessary to fit the individual case.

Although the basic method of this invention finds utility in and of itself, its greatest benefit is derived through its combination with other steps to effectuate a clinical procedure for indication and permanent cure of resulting painful syndromes.

The cure of the resulting painful syndromes stems from the adjustment of the teeth so as to do away with the dental cause of the shift of avooidance or condyle migration. In order for this cure to be effected, the spots needing adjustment must first be located.

It is therefore a part of this invention to provide a method for indicating these spots or points of irritation. Basically, the method contemplated for this purpose comprises the steps of first placing an indicating means upon the occlusal surface of the teeth. Next, the mandible and its condyles are placed in temporary centric position using the basic method hereinbefore set out for accomplishing this purpose. Finally, the deflecting muscle action, which would reassert itself if the patient were allowed to quickly bite down or the dentist were to manually tap the patients teeth together on the indicating means, is by-passed by applying the basic technique as set forth in U.S. Pat. No. 3,098,298, thereby accurately indicating the high and low spots on the indicating means that must be removed to achieve permanent mandibular equilibration.

The indicating means that may be used herein are any of those conventional indicating means now used in the spot grinding technique or in the indicating technique of U.S. Pat. No. 3,098,298. A preferred form of indicating means, however, is a thin sheet of aluminum foil having thereon a coating of a conventional adhesive which permits meticular adhesion and adaptation of the foil to tooth surfaces. This sheet is then carefully placed in the mouth and adapted to the surfaces of the teeth. An abrasive jelly, conventional in the art, is then applied to the tooth surfaces. Actual indication of offending areas may then be accomplished by imparting by-passing vibrations as per U.S. Pat. No. 3,098,298 to the mandible until first tooth contact. The vibrating teeth in the presence of the abrasive jelly will cause facets of wear to appear on the polished surfaces of the adapted foil. The facets of wear are the indicators of initial contact.

Although a full explanation of the by-pass technique and apparatus is given in U.S. Pat. No. 3,098,298, and its adaptation to this invention is readily apparent to the skilled artisan once given the present disclosure, it may be generally stated that it comprises applying to the mandible in its open position but after removal of the pressure, pivots, or cuffs an intermittent elevating force of sufilcient frequency to raise the lower teeth to a point at which first contact with the upper teeth is made. The importance of going to first contact only is clear, since forcing beyond this point tends to shift the mandible and thus cause false indication of unoffending points of teeth contact.

The intermittent elevating force generally is in the nature of vibrations. By vibration is meant a movement in one direction up or down. Therefore, a complete cycle, consisting of one movement in the upward direction followed by one movement in the downward direction, under the definition of vibration will consist of two such vibrations or movements opposite in direction. This meaning of vibration has been selected to emphasize that movement in one direction is as important as movement in the other direction.

The apparatus most preferred for providing this elevating force is described in U.S. Pat. No. 3,098,298 (as heretofore set forth, being incorporated herein by reference) and includes a vibrator and a chin rest.

This apparatus coupled with the definition of vibration above set forth shows that the motion of the chin rest in the upward direction elevates the mandible, while the motion in the downward direction permits the depressor muscles to force the mandible downward. It is pointed out here that the depressor muscles are not the -ones which act to cause the shift of avoidance or condyle pressor and bracing muscles. This tendency to disrupt the process as vibrations are lowered in frequency varies from patient to patient. For some patients 80 vibrations per second, or 40 complete cycles per second, or even a lesser frequency Will be a sufficiently rapid movement at which to conduct the process successfully without the patient causing jaw deflection through undesirable muscle action from the muscles which cause a shift of avoidance.

Just as the vibrations must be rapid, they must not be too rapid. The upper limit varies according to the frequency for each individual patient at which there is a reflex contraction of the deflecting (usually the elevator) muscles which would disrupt the process. It is preferable that the vibrations not exceed 300 to 150 cycles for most patients.

According to the above-described indicating process, then, the true offending areas which are causing muscles spasms and other syndromes are fully and accurately marked and recorded. There is, therefore, no need for additional recording of initial contact other than those recorded as facets of wear on the adapted foil.

Once the offending areas have been indicated and recorded, the patient may then be treated for permanent cure. The process of permanent cure generally comprises the additional step of adjusting the indicated spots as required. This additional step may assume forms depending upon the nature and type of spot to be adjusted. For example, if the spot is a high spot which causes a hole to be formed in the indicating foil, the spot may be spotground by conventional techniques directly through the hole without the necessity of removing the foil indicating means from the teeth. If, on the other hand, the spot requires extensive grinding or if it is a high dental filling which must be removed or replaced, the indicating means are removed and the spot is corrected by grinding, replacement, etc. as indicated. As to those high spots of only slight elevation, a convenient technique for accomplishing adjustment thereof is merely to use the abrasive indicating jelly as a grinding jelly and grind down the spots using the above-described vibrator. That is to say, if the patient, up until this time, has not been permitted to reassert the use of the elevator muscles or other deflecting muscles, the intermittent vibrations may merely be reapplied to first contact and allowed through their up and down motion to grind away the slight or small high spot. If, however, the patient has been permitted to reassert the deflecting muscles and thus cause mandibular (and thus condyle) migration, centric position of the mandible by the methods hereinbefore set forth must again be established in order to assure that the reapplication of intermittent force will cause grinding of the heretofore accurately indicated spot. If, as a further example, the spot is a space vacated by the removal of a tooth, an artificial denture may be constructed and inserted.

Clinically, if there is any doubt as to whether the patient has or has not reasserted the deflecting muscles, repositioning of the mandible in its centric position will be routinely done.

As a matter of practice, it is seen that if, for example, the high spot being ground is also a high spot which is causing noncentric occlusion of the teeth, that in fact the equilibration method hereinabove set forth actually accomplishes both the equilibraation of the mandible and its condyles as well as the accurate equilibration of the occlusions of the teeth.

It is understood, of course, that although in some instances one treatment will effect a complete equilibration of the mandible and the occlusions of the teeth, that in many instances due to the amount of grinding, etc. that must be done, two, three or even more treatment sessions will be necessary.

It is also understood that although in some instances mandibular equilibration will also result in occlusal equilibration, in many instances occlusal equilibration as in US. Pat. No. 3,098,298 will be done by a separate process or treatment which either precedes or follows the mandibular equilibration process as hereinabove set forth. This is especially true in instances, for examples, Where occlusal high spots are located in teeth which are mandibular low spots.

It is further understood that if more than one high spot exists, the methods described hereinabove will preferably be repeated a sufficient number of times so as to remove all the high spots and thereby achieve full mandibular equilibrium.

Arising out of the above described techniques for achieving mandibular equilibration is a novel and highly successful method of replacing missing posterior teeth. By posterior teeth is meant the bicuspids and molars.

This method generally comprises the steps of constructing within the space vacated by one or more missing posterior teeth, a temporary denture of a conventional material such as plastic. This temporary denture is of a height slightly less than its surrounding teeth. That is to say, the temporary denture is of a height such that when the teeth are naturally closed, no contact is made by this denture with any opposing teeth. The reason for this will become clear as the rest of the method is hereinafter disclosed. With this temporary denture in place, the basic equilibration method set forth above is performed leaving the patient in an open mouth position wherein the mandible has been located in its correct centric position. The pressure, pivots, or cuffs are then removed along with the temporary denture. Next a permanent denture is formed according to conventional procedures and is coated with a moldable dental material which when set will form a part of the permanent denture. An example of such material is an acrylic resin commonly used for making false teeth. This coating is primarily applied to the occlusal surface of the teeth to a sufficient height such that when brought into contact with the opposing teeth, this denure will provide the first contact of the teeth and will allow proper and full occlusions to be molded in the material by the opposing teeth.

While still moldable, the coated denture is inserted into place in the mouth. Of course, it is realized that up until this time the patient has been kept still and not permitted in any way to assert the use of deflecting muscles, since such would then destroy the centric position of the mandible achieved in an early step. The intermittent force as hereinbefore described is then applied to drive the mandible through the depressor muscle action and into first contact with the teeth. Preferably, any high spots in the other teeth of the month have been first removed by one of the methods described above, thus assuring that first contact will be contact with the moldable denture. However, if this is not the case, the high spots at this time should then be removed in order until the moldable denture provides the first point of contact. When this is achieved the intermittent elevating force is elevated slightly and permitted to continue until the opposing teeth have formed the moldable denture into full and centric occlusions. Such a tooth will also not present any problem to mandibular centricity, since it has been molded with the mandible in its centric position.

Clinically the method is then concluded by smoothing the sides of the denture, allowing the moldable resin to harden, rinsing the mouth of any debris, and checking the equilibration of the mandible and its condyles by reusing the high and low spot indicating method hereinabove described.

This invention also contemplates within its scope apparatus which may be used in the diagnosis and cure of noncentric mandible problems.

One type of apparatus contemplated for use comprises at least two resilient pivots connected there between by conduit means for transmitting a compressing force in one pivot into an expansion force in the other pivot.

Although the above apparatus may be of many types, FIG. 1 depicts an especially preferred type of apparatus for use in performing the equilibration methods of this invention. Referring to this figure, there is provided a pair of endotrachial cuffs 8 made of an expandable elastic rubber and having a hollow portion 4 and an outside cylindrical bladder 6 capable of resilient expansion and of being filled with a fluid. The internal fluid chambers of these bladders 6 are connected by hollow flexible conduits 10, usually of rubber or plastic, and a hollow T bar or conduit 12 whose T ends 14 are connected to the conduits and whose base end 16 is connected to a conventional controllable pressure source (not shown) at its end 19. Conduit 18 is provided with a screwcock means 20 for pinching conduit 18 shut or releasing pressure held within the system.

This apparatus is used herein by first pressurizing the system to any convenient pressure as with a syringe attached to end 19 While screwcock 20 is in open position. Screwcock 20 is then closed to retain the pressure in the system, i.e., bladder 6 is in expanded condition, and the pressure source is removed from end 19. Endotrachial culfs 8 are then inserted in a patients open mouth between the teeth at a point, one cuff each, above each of the first mandibular molars. The patient then bites down lightly to retain the cuffs in this position. As is apparent, these cuffs now serve as a resilient pressure whereupon the various methods of equilibrating and indicating as hereinbefore described are now performed.

Another type of apparatus contemplated for use comprises at least two independently compressible and expandable resilient pivots, pressure regulator means connected to each independent set of pivots for independently regulating the pressure in each set of pivots, and gauge means for indicating the separate pressures in each independent set of pivots.

The pivot means contemplated for use in this apparatus may be of many types, for example, hydraulic pivots, mechanical pivots, or pneumatic pivots. Likewise, the pressure regulator means and gauge means may assume many conventional types and designs such as, for example, syringes and manometers respectively. The pivots may also be two in number or in sets of greater than two.

Although the novel apparatus contemplated above is not limited to any single set-up or arrangement, an especially preferred embodiment of this apparatus is shown in FIG. 2. On a stand means 1 there are mounted two independent U tube manometers 2 and two syringe means 3, one each connected to the open end of each U-tube manometer 2 by a hollow T bar or conduit 12, such that the syringe 3 is connected to the base 16 of the T while the open end of the manometer is connected to one branch of the T portion 14 thereof. To the other branch of the T portion 14 of each T conduit 12 is connected a conduit itself connected internally to an outer resilient expandable bladder 6 of an endrotrachial cuff 8 having a hollow portion 4 of the type described in FIG. 1. As shown in FIG. 2, each side of the system is independent of the other. This independence enables this apparatus to be used both as a diagnostic device and as an equilibration device.

For example, the apparatus may be used as an equilibration device when the mandibular problem is solely one of front teeth being higher than back teeth or vice versa, such that both condyles are equally separated too far or too close to their fossae. In this instance, the syringe means 3 by lowering plunger 23 pressurizes each bladder 6 to the same pressure as recorded on manometers 2. Screwcock 20 is then closed to retain the pressure in the system. Each endotrachial cuif is then placed in a patients open month, one above each first mandibular molar. The patient then lightly bites down to hold the cuffs in position. These cuffs now serve as a resilient pressure whereupon the various appropriate methods of equilibrating and indicating as hereinbefore described are now performed.

As hereinabove stated, the apparatus may be used to diagnose mandibular noncentricity. In this instance, the bladders 6 are equally pressurized as in the preceding example. A patient whose condition has not yet been diagnosed is seated in a dental chair. The equally pressurized endotrachial cuffs 8 are then inserted as before at the location of the first mandibular molar. The patient then bites to occlusion but not hard enough to damage the rubber of the cuffs 8 and allowed to open far enough to cause complete separation of the teeth but not far enough so as to loose completely the compression of the cuffs or cause translational, as opposed to rotational, motion of the condyles and mandible. Such limits on motion are easily viewed and controlled by one skilled in the art and in practice may be controlled by maintaining teeth separation between about 1 mm. to about 8 mm. depending upon the patient. At this point the patient holds this position for a period of from about 1 to 15 minutes during which time mandible motion towards its centric position, if indeed it is out of centricity, will be recorded as a moving pressure change on the manometers during this period and/or will be indicated by a relief from pain and other syndromes. Once the problem is diagnosed, one or more of the methods hereinabove described may be used to indicate the points or trouble and equilibrate the mandible and its condyles.

Of course, it is realized that this novel apparatus and especially the one depicted in FIG. 2 may be used to hasten or aid equilibration by adjusting the syringe or pressure means during equilibration, thereby accurately controlling both compression force and equilibration.

PREFERRED EMBODIMENTS Although the inventions described hereinbefore are in no way limited to the following examples, these examples comprise the best mode for carrying out the above-described inventions.

EXAMPLE 1 A patient experiencing various head syndromes is seated in a dental chair. The apparatus of FIG. 2 is then used for diagnostic purposes as hereinbefore described to record any mandible motion or to effect any temporary relief from pain. A teeth separation of 4 mm. a pressure of 50 p.s.i. in a inch outside diameter expanded rubber endotrachial cuff, and a waiting period of 10 minutes is used. A resulting, moving change in pressure and relief of pain during this period indicates that the mandible needs to be equilibrated.

The apparatus of FIG. 2 is then removed and the occlusions of the teeth are checked and equilibrated as per the method disclosed in applicants US Pat. No. 3,098,- 298, using a frequency of 60 cycles per second. After occlusal equilibration, the teeth are again checked with the apparatus of FIG. 2 to see if the removal of occlusal high spots also removed the impediments to mandibular centricity. Usually it is found that the two problems are at least partially mutually exclusive.

If this is the case, the apparatus of FIG. 2 is removed and the apparatus of FIG. 1 is pressurized to 50 p.s.i. and closed off by closing screwcock 20. Endotrachial cuffs 8 are then inserted between the teeth, one each above each of the first mandibular molars. The patient then bites to occlusion and relaxes to separation of about 5 mm., the cuffs still being substantially compressed between the teeth. The patient is then permitted to remain in this position for approximately 15 minutes whereupon the cuffs are removed and without further movement of the jaw, aluminum foil strips coated with an adhesive are placed on the occlusal surfaces of the mandibular teeth. An abrasive jelly is then applied to the upper teeth. A vibrator of the type described in US. Pat. No. 3,098,298, is then vibrated at 60 cycles vibrations) per second and applied by its chin rest to the lower jaw. The apparatus is then elevated until the maxillary and mandibular teeth make first contact only. This point is indicated audibly to the operator. The apparatus is permitted to vibrate in this position for a few seconds for example) to insure that high and low points will be indicated on the foil. The apparatus is then removed and spot grinding of indicated high spots which have formed holes in the foil are then spot ground direutly through the foil indicating means.

Depending upon the indications, further high spots such as dental fillings etc. are then ground down or replaced and/or low spots built up by conventional means. The patients mouth is then rinsed of debris and the aluminum foil indicating method is again used to check for mandibular centricity.

Further work necessary as indicated by this check may then be done by re-performing the above method immediately or at another visit depending upon the fatigue and condition of the patient. In this respect, any small or slight high spots remaining are ground down merely by using the abrasive jelly as a grinding jelly and grinding directly with the vibrator. The final check with the foil will indicate that both occlusal and mandibular centricity has been realized.

EXAMPLE 2 In the method of replacing missing teeth hereinbefore described, a polystyrene temporary denture is inserted in a space left by a missing second molar of an otherwise equilibrated mouth. The temporary denture has a height of approximately 1 mm. less than its neighboring first molar. The temporary mandibular equilibration method (i.e. wherein the mandible is equilibrated but final adjusting of the teeth is not done) using the apparatus of FIG. 1 is then performed using a time of minutes and a separation of 4 mm. The cuffs 8 and temporary denture are removed from the patients mouth without the patient being permitted to use any of the deflecting muscles. While the patient is in this open resting position, a permanent denture is prepared having a coating of moldable denture acrylic resin thereon, the total denture being of a height approximately 3 mm. more than the height of the temporary denture. This permanent denture is then put into place in the mouth and a vibrating apparatus of the type described in US. Pat. No. 3,098,298, is then employed as described hereinabove using a frequency of 120 vibrations (60 cycles) per second to drive the mandible through the depressing muscle action to first tooth contact which in this instance is contact with the protruding height of the moldable resin denture. The vibrator is then elevated slightly and allowed to vibrate until the proper occlusal surface of the denture is formed by its corresponding contacting maxillary teeth (approximately seconds). The vibrating apparatus is then removed and the denture is touched up for mouth comfort. Debris is then removed from the patients mouth. A permanent and fully equilibrated false tooth is thereby formed.

The above examples and detailed description through complete, do not limit the scope of the herein disclosed inventions since many different forms and variations of these inventions will become apparent to the skilled artisan and thus are also included within the intent and scope thereof.

I claim:

1. A method for alleviating a painful syndrome resulting from a dislocated mandible comprising the steps of interposing a resilient pressure means at substantially the pivotal point of the mandible between the upper and lower teeth on each side of said mandible, closing the lower teeth toward the upper teeth to compress said resilient pressure means, opening the upper and lower teeth to full separation but only far enough to maintain at least partial compression of said pressure means on each side of the mandible, and maintaining said upper and lower teeth under said partial compression for a period of about 15 minutes until the dislocated mandible is relocated and equilibrated and the painful syndrome is relieved.

2. A method as in claim 1 wherein said opening of the teeth is only far enough to achieve rotation but not translation of the mandibles condyles in their forssae.

3. A method as in claim 1 wherein said closing of the lower teeth is to occlusion with the upper teeth.

4. A method as in claim 1 wherein said resilient pressure means is provided by interposing at the pivotal point of the mandible on each side thereof between the upper and lower teeth an expandable and compressable pneumatic pivot, each pivot being interconnected with the other such that a larger compression force in one pivot will result in a larger expansion force in the other pivot.

5. A method of fully equilibrating a mandible comprising the steps of interposing a resilient pressure means at substantially the pivotal point of the mandible between the upper and lower teeth thereby extending the pressure of said resilient means to each side of the mandible, closing the lower teeth toward the upper teeth to occlusion and thereby compressing said resilient pressure means, opening the upper and lower teeth to full separation but only far enough to maintain at least partial compression of said pressure means on each side of said mandible and not far enough to cause translation movement of the mandibles condyles in their fossae, and maintaining said upper and lower teeth under partial compression for a period of about 15 minutes until the mandible moves into correct centric position.

6. A method of equilibrating a mandible in its vertical plane to thereby at least partially eliminate condyle migration comprising the steps of disposing an indicating means on an occlusal surface of the teeth, interposing a resilient pressure means at substantially the pivotal point of the mandible between the upper and lower teeth on each side of said mandible, closing the lower teeth toward the upper teeth to compress said resilient pressure means, opening the upper and lower teeth to full separation but only far enough to maintain at least partial compression of said pressure means on each side of said mandible, thereafter applying to the mandible an intermittent elevating force having a frequency range of up to about 300 cycles per second to raise the lower teeth to a point at which first contact with the upper teeth is made, and adjusting the high points and low points of such contact as indicated.

7. A method as in claim 6 wherein said separation is also only far enough to achieve rotation but not translation of the mandibles condyle heads in their fossae.

8. A method as in claim 7 wherein the closing of the lower teeth is to occlusion with the upper teeth, the intermittent elevating force has a frequency rate of from about 40 to cycles per second, and the time lapse between the separation of the teeth and the application of force to the mandible is from about 1-15 minutes.

9. A method as in claim 8 wherein said adjusting of high spots includes the steps of applying on the occlusal surfaces of the teeth an abrasive compound and reapplying said intermittent force to first contact of the teeth for a sufficient period of time and a sufficient number of times to eliminate said high spots.

10. A method as in claim 9 wherein said reapplication of force is effected for a sufficient period of time to also eliminate high spots which are causing noncentric occlusion of the upper and lower teeth.

11. A method of accurately indicating high and low spots which cause mandibular migration in its vertical plane comprising the steps of placing an indicating means on an occlusal surface of the teeth, interposing a resilient pressure means at substantially the pivotal point of the mandible between the upper and lower teeth on each side of said mandible, closing the lower teeth toward the upper teeth to compress said resilient pressure means, opening the upper and lower teeth to full separation but only far enough to maintain at least partial compression of said pressure means on each side of said mandible, thereafter applying to the mandible an intermittent elevating force having a frequency range of up to 300 cycles per second to raise the lower teeth to a point at which first contact with the upper teeth is made, and recording on said indicating means the points of contact of said teeth.

12. A method as in claim 11 wherein said separation is also only far enough to achieve rotation but not translation of the mandibles condyle heads in their fossae.

13. A method as in claim 12 wherein the closing of the lower teeth is to occlusion with the upper teeth, the intermittent elevating force has a frequency range of from about 40 to 150 cycles per second, and the time lapse between the separation of the teeth and the application of force to the mandible is from about 1-15 minutes.

14. A method of replacing and equilibrating missing posterior teeth comprising the steps of constructing within the space vacated by said missing posterior teeth a temporary denture of a height such that when the teeth are naturally closed, no contact is made with the temporary denture, inserting a resilient pressure at substantially the pivotal point of the mandible between the upper and lower teeth on each side of said mandible, closing the lower teeth toward the upper teeth to compress said resilient pressure, opening the upper and lower teeth to full separation but only far enough to maintain at least partial compression of said pressure on each side of said mandible, allowing a period of time to elapse of from about 1 to 15 minutes, removing said resilient pressure and said temporary denture, inserting within said space vacated by the temporary denture a moldable denture of a height sufiicient such that when the next following step is performed the said moldable denture will be the first point of contact between the teeth, applying to the mandible an intermittent elevating force at a frequency within the range of about 40 to 150 cycles per second to raise the lower teeth to a point at which the moldable denture contacts its corresponding occlusal teeth, continuing the application of the intermittent force for a sufiicient period of time to shape the occlusal surface of said moldable denture in correct centric relation with said corresponding occlusal teeth.

15. A method according to claim 14 wherein said initial closing of the teeth is to occlusion and said opening of the teeth is also only far enough to achieve rotation but not translation of the mandibles condyles in their fossae.

16. An apparatus for diagnosing mandibular noncentricity and for equilibrating a mandible of a patient com prising at least two independently compressible and expandable resilient pivots, pressure regulator means connected to each independent set of pivots for independently regulating the pressure in each set of pivots, and gauge means connected to each independent set of pivots for indicating the separate pressures in each independent set of pivots whereby the pressure of the resilient pivots may be indicated and regulated when the pivots are placed above the mandibular molars of the patients mouth.

17. An apparatus according to claim 16 wherein said independently compressible and expandable resilient pivots are pneumatic pivots and said pressure regulator means and gauge means comprising for each set of independent pivots a syringe means connected by a conduit means to the pivot set and to a manometer, the conduit means being connected such that the syringe controls pressure in the pivots and the pressure in the pivots is recorded by the manometer.

References Cited UNITED STATES PATENTS 3,297,021 1/1967 Davis et al 32l9 XR 3,349,489 10/ 1967 Shackelford 32-19 3,390,459 7/1968 Seidenberg 3219 

